What are the brand names of mineralocorticoids (Mineralocorticoid Receptor Agonists) and glucocorticoids (Glucocorticoid Receptor Agonists), such as Aldactone (Spironolactone), and which ones are most commonly used to treat primary aldosteronism?

From the Guidelines

For primary aldosteronism, the most commonly used mineralocorticoid receptor antagonists are spironolactone (brand name Aldactone) and eplerenone (Inspra), with spironolactone being the first-line medication at doses of 50-100 mg daily, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. The brand names of the mineralcorticoids include Aldactone (spironolactone) and Inspra (eplerenone), while common glucocorticoids include Deltasone (prednisone), Orapred (prednisolone), Decadron (dexamethasone), Cortef (hydrocortisone), and Medrol (methylprednisolone) 1. Some key points to consider when treating primary aldosteronism include:

• The effective dose of spironolactone can be titrated up to 300-400 mg once daily, if necessary 1
• Eplerenone is also used and has the advantage of causing less gynaecomastia and erectile dysfunction in men, despite being less potent than spironolactone and requiring twice-daily administration 1
• Newer agents, such as the non-steroidal MRAs finerenone and exarenone, and the aldosterone synthase inhibitor baxdrostat, are also being tested for treating primary aldosteronism 1
• For familial forms of primary aldosteronism, only glucocorticoid-remediable primary aldosteronism can be corrected with dexamethasone, usually with low doses that are free of glucocorticoid effects and can be safely used during pregnancy 1
• The diagnosis of primary aldosteronism generally requires a confirmatory test, such as the intravenous saline suppression test or oral salt-loading test, and adrenal venous sampling to determine whether the increased aldosterone production is unilateral or bilateral in origin 1. Treatment with spironolactone or eplerenone is effective in lowering blood pressure and reversing left ventricular hypertrophy in patients with primary aldosteronism, and should be accompanied by regular monitoring of blood pressure, serum potassium, and renal function to ensure efficacy and prevent complications 1.

From the FDA Drug Label

Spironolactone tablets are indicated in the following settings: Short-term preoperative treatment of patients with primary hyperaldosteronism. Long-term maintenance therapy for patients with discrete aldosterone-producing adrenal adenomas who are not candidates for surgery Long-term maintenance therapy for patients with bilateral micro or macronodular adrenal hyperplasia (idiopathic hyperaldosteronism).

The brand names of mineralcorticoids and glucocorticoids are not explicitly mentioned in the provided drug labels. However, spironolactone and eplerenone are mentioned as drug names.

• Spironolactone is used for the treatment of primary hyperaldosteronism.
• The most used mineralcorticoid for primary aldosteronism is spironolactone 2 2. No information is provided about glucocorticoids in the context of primary aldosteronism.

From the Research

Mineralocorticoids and Glucocorticoids

• Mineralocorticoids are a class of corticosteroids that are produced by the adrenal cortex and play a crucial role in regulating electrolyte and water balance in the body.
• Glucocorticoids, on the other hand, are a class of corticosteroids that are involved in regulating glucose metabolism, immune response, and inflammation.

Brand Names of Mineralocorticoids and Glucocorticoids

• The brand names of mineralocorticoids include:
  • Spironolactone (Aldactone) 3, 4
  • Esaxerenone (Xpreza) 4
• The brand names of glucocorticoids are not specifically mentioned in the provided studies.

Treatment of Primary Aldosteronism

• Primary aldosteronism is a condition characterized by excess production of aldosterone, a mineralocorticoid hormone.
• The treatment of primary aldosteronism depends on the underlying cause and may involve:
  • Mineralocorticoid receptor antagonists, such as spironolactone and esaxerenone, for bilateral disease 5, 3, 6, 4
  • Adrenalectomy, or surgical removal of the adrenal gland, for unilateral disease 5, 3, 7, 6
• Mineralocorticoid receptor antagonists, such as spironolactone, are commonly used as first-line treatment for primary aldosteronism, particularly in patients with bilateral disease 5, 3.